意外胆囊癌的诊治及术后生存影响因素分析

Diagnosis,treatments for accidental gallbladder cancer and its postoperative survival influencing factors

目的探讨意外胆囊癌诊治及腹腔镜胆囊切除术(LC)后生存影响因素。方法回顾性分析2010年5月至2015年3月在江南大学附属医院行LC的37例意外胆囊癌患者临床资料。其中男13例,女24例;年龄27~79岁,中位年龄61岁。Nevin分期Ⅰ期11例,Ⅱ期9例,Ⅲ期10例,Ⅳ期6例,Ⅴ期1例。患者均签署知情同意书,符合医学伦理学规定。分析患者的诊治方法及术后生存影响因素。生存分析采用Kaplan-Meier法和Log-rank检验。结果意外胆囊癌发生率为1.39%(37/2 653)。术前诊断为胆囊结石29例,胆囊息肉8例。术中快速病理诊断胆囊癌25例,其中6例行单纯LC,19例中转开腹行胆囊癌根治术。术后病理检查诊断胆囊癌12例,其中5例行再次开腹胆囊癌根治术。R0切除29例,R1或R2切除8例。患者术后1、3、5年生存率分别为78.3%、35.1%、29.7%。肿瘤分化程度、淋巴结转移、Nevin分期、胆囊壁厚度、手术方式与患者术后生存有关(χ^(2)=5.871,9.981,12.231,11.291,11.321;P<0.05)。结论肿瘤分化程度、淋巴结转移、Nevin分期、胆囊壁厚度、手术方式是意外胆囊癌患者LC术后生存的影响因素。胆囊癌早期诊治可取得较好的临床预后。

Objective To explore the diagnosis and treatments for the accidental gallbladder cancer and the influencing factors of the survival after laparoscopic cholecystectomy(LC).Methods Clinical data of 37 patients with accidental gallbladder cancer who underwent LC in the Affiliated Hospital of Jiangnan University from May 2010 to March 2015 were retrospectively analyzed.Among them,13 patients were male and 24 female,aged from 27 to 79 years with a median age of 61 years.11 patients were classified as Nevin stageⅠ,9 cases stageⅡ,10 cases stageⅢ,6 cases stageⅣand 1 case stageⅤ.The informed consents of all patients were obtained and the local ethical committee approval was received.The diagnosis,treatments and influencing factors of the postoperative survival were analyzed.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results The incidence of accidental gallbladder cancer was 1.39%(37/2653).Preoperatively,29 patients were diagnosed with gallstones and 8 cases were with gallbladder polyps.Intraoperatively,25 cases were diagnosed with gallbladder cancer by rapid pathological examination.Among them,6 cases were only treated with LC,and 19 cases were converted to open radical resection of gallbladder cancer.12 cases were diagnosed with gallbladder cancer by postoperative pathological examination,including 5 cases underwent secondary open radical resection of gallbladder cancer.29 patients underwent R0 resection,and 8 cases R1/R2 resection.The postoperative 1-,3-and 5-year survival rates were 78.3%,35.1%and 29.7%,respectively.Tumor differentiation,lymph node metastasis,Nevin stage,thickness of gallbladder wall and surgical procedures were significantly associated with the postoperative survival(χ^(2)=5.871,9.981,12.231,11.291,11.321;P<0.05).Conclusions Tumor differentiation,lymph node metastasis,Nevin stage,thickness of gallbladder wall and surgical procedures are the influencing factors of the survival in patients with accidental gallbladder cancer after LC.Early diagnosis and treatments can achieve favorable clinical prognosis for gallbladder cancer patients.